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A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI)

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Abstract

Purpose

Several bony and soft tissue procedures have been described for the treatment of hallux valgus, and currently mini-invasive surgical techniques are preferred in order to reduce surgical trauma, complications, time of surgery and to allow an earlier recovery. The aim of this study is to analyse a series of 1,000 consecutive cases of hallux valgus, surgically treated by the minimally invasive SERI technique, reporting results at mid-term follow-up.

Methods

We prospectively studied 641 patients (1,000 feet) with symptomatic hallux valgus surgically treated by SERI osteotomy. Inclusion criteria were: age between 20 and 65 years, reducible mild or moderate hallux valgus, HVA ≤ 40°, IMA ≤ 20°, and arthritis of the first metatarsophalangeal joint up to grade 2 according to the Regnauld classification.

Results

The American Orthopaedic Foot and Ankle Society (AOFAS) score rose from 46.8 ± 16.7 preoperatively to 89 ± 10.3 at last follow-up. Radiographic control at follow-up showed a complete healing of the osteotomy and remodelling of the metatarsal bone. Low rate of complication has been reported.

Conclusions

This study demonstrated that the SERI technique is effective in treating mild to moderate hallux valgus in terms of relief from symptoms and functional improvement. This technique allowed correction of the main parameters of the deformity, with durable clinical and radiographic results at a mid-term follow-up.

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References

  1. Coughlin MJ (1996) Hallux valgus. J Bone Joint Surg Am 78:932–966

    PubMed  CAS  Google Scholar 

  2. Hardy RH, Clapham JCR (1951) Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br 33:376–391

    PubMed  Google Scholar 

  3. Hardy RH, Clapham JCR (1952) Hallux valgus. Lancet 1:1180–1183

    Article  PubMed  CAS  Google Scholar 

  4. Coughlin MJ (1995) Juvenile hallux valgus: etiology and treatment. Foot Ankle Int 16:682–697

    Article  PubMed  CAS  Google Scholar 

  5. Piqué-Vidal C, Solé MT, Antich J (2007) Hallux valgus inheritance: pedigree research in 350 patients with bunion deformity. J Foot Ankle Surg 46:149–154

    Article  PubMed  Google Scholar 

  6. Barnicot NA, Hardy RH (1955) The position of the hallux in West Africans. J Anat 89:355–361

    PubMed  CAS  Google Scholar 

  7. Barouk LS, Diebold P (1991) Hallux valgus congenital. Med Chir Pied 7:65–112

    Google Scholar 

  8. Coughlin MJ, Jones CP (2007) Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int 28:759–777

    Article  PubMed  Google Scholar 

  9. Devos Bevernage B, Leemrijse T (2009) Hallux varus: classification and treatment. Foot Ankle Clin 14:51–65

    Article  PubMed  Google Scholar 

  10. Dragonetti L (1997) Inquadramento eziopatogenetico e clinico dell’alluce abdotto-valgo. In: Malerba F, Dragonetti L, Giannini S (eds) Progressi in Medicina e Chirurgia del Piede. L’Alluce Valgo. Aulo Gaggi Editore, Bologna, pp 155–165

    Google Scholar 

  11. Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part I: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int 28:654–659

    Article  PubMed  Google Scholar 

  12. Engle E, Morton DJ (1931) Notes of foot disorders among natives of the Belgian Congo. J Bone Joint Surg Am 13:311–319

    Google Scholar 

  13. James CS (1939) Footprints and feet of natives of Soloman Island. Lancet 2:1390–1393

    Article  Google Scholar 

  14. Johnston O (1956) Further studies of the inheritance of hand and foot anomalies. Clin Orthop Relat Res 8:146–160

    CAS  Google Scholar 

  15. Hohmann G (1925) Der Hallux Valgus und die übrigen Zehenverkrümmungen. Ergeb Chir Orthop 18:308–376

    Article  Google Scholar 

  16. Mann RA, Coughlin MJ (1999) Adult hallux valgus. In: Coughlin MJ, Mann RA (eds) Surgery of the foot and ankle. Mosby, St. Louis, pp 150–269

    Google Scholar 

  17. Pontius J, Kieran D, Mahan T, Carter S (1994) Characteristics of adolescent hallux abductus-valgus. A retrospective review. J Am Podiatr Med Assoc 84:208–218

    Google Scholar 

  18. Root ML, Orien WP, Weed JH (2001) Deformità dell’avampiede causate dall’anomala pronazione della sottoastragalica. In: Root ML, Orien WP, Weed JH (eds) La fuzionalità del piede normale e patologico. Piccin, Padova, pp 333–435

    Google Scholar 

  19. Sim-Fook L, Hodgson AR (1958) A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg Am 40:1058–1062

    PubMed  Google Scholar 

  20. Veri JP, Pirani SP, Claridge R (2001) Crescentic proximal metatarsal osteotomy for moderate to severe hallux valgus: a mean 12.2 year follow-up study. Foot Ankle Int 22:817–822

    PubMed  CAS  Google Scholar 

  21. Austin DW, Leventen EO (1981) A new osteotomy for hallux valgus: a horizontally directed “V” displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop Relat Res 157:25–30

    PubMed  Google Scholar 

  22. Bosch P, Markowski H, Rannicher V (1990) Technik und erste Ergebnisse der subkutanen distalen Metatarsale-I-Osteotomie. Orthopaedische Praxis 26:51–56

    Google Scholar 

  23. Chou LB, Mann RA, Casillas MM (1998) Biplanar chevron osteotomy. Foot Ankle Int 19:579–584

    Article  PubMed  CAS  Google Scholar 

  24. Chang JT (2001) Distal metaphyseal osteotomies in hallux abducto valgus surgery. In: Banks AS, Downey MS, Martin DE, Miller SJ (eds) McGlamry’s comprehensive textbook of foot and ankle surgery. Lippincott, Williams & Wilkins, Philadelphia, pp 505–527

    Google Scholar 

  25. Coetzee JC, Wickum D (2004) The Lapidus procedure. A prospective cohort outcome study. Foot Ankle Int 25:526–531

    PubMed  Google Scholar 

  26. Corte-Real NM, Moreira RM (2009) Modified biplanar chevron osteotomy. Foot Ankle Int 30:1149–1153

    Article  PubMed  Google Scholar 

  27. Chuckpaiwong B (2012) Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. Int Orthop 36:2275–2278

    Article  PubMed  Google Scholar 

  28. Fuhrmann RA, Zollinger-Kies H, Kundert HP (2010) Mid-term results of Scarf osteotomy in hallux valgus. Int Orthop 34:981–989

    Article  PubMed  Google Scholar 

  29. Giannini S, Ceccarelli F, Bevoni R, Vannini F (2003) Hallux valgus surgery: the minimally invasive bunion correction (SERI). Tech Foot Ankle Surg 2:11–20

    Article  Google Scholar 

  30. Groulier P, Curvale G (1992) Postoperative iatrogenic hallux varus. Surgical treatment. Rev Chir Orthop Reparatrice Appar Mot 78:449–455

    PubMed  CAS  Google Scholar 

  31. Jawish R, Assoum H, Saliba E (2010) Opening wedge osteotomy of the first cuneiform for the treatment of hallux valgus. Int Orthop 34:361–368

    Article  PubMed  Google Scholar 

  32. Kadakia AR, Smerek JP, Myerson MS (2007) Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int 28:355–360

    Article  PubMed  Google Scholar 

  33. Lamprecht E (1996) Die retrokapitale Metatarsale-I-Osteotomie nach Kramer zur Behandlung des Hallux valgus. In: Meyer RP, Kappeler U (eds) Fußchirurgie in der Praxis. Springer-Verlag Berlin Heidelberg, Germany, pp 145–157

    Chapter  Google Scholar 

  34. Lucijanic I, Bicanic G, Sonicki Z, Mirkovic M, Pecina M (2009) Treatment of hallux valgus with three-dimensional modification of Mitchell's osteotomy: technique and results. J Am Podiatr Med Assoc 99:162–172

    PubMed  Google Scholar 

  35. Magerl F (1982) Stabile Osteotomien zur Behandlung des Hallux valgus und Metatarsale I varum. Orthopade 11:170–180

    PubMed  CAS  Google Scholar 

  36. Magnan B, Pezzè L, Rossi N, Bartolozzi P (2005) Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J Bone Joint Surg Am 86:1191–1199

    Article  Google Scholar 

  37. Mitchell CL, Fleming JL, Allen R, Glenney C, Sanford G (1958) Osteotomy-bunionectomy for hallux valgus. J Bone Joint Surg Am 40:41–58

    PubMed  Google Scholar 

  38. Nery CAB, Barroco RUB, Ressio C (2002) Biplanar chevron osteotomy. Foot Ankle Int 23:792–798

    PubMed  Google Scholar 

  39. Sanna P, Ruiu GA (2005) Percutaneous distal osteotomy of the first metatarsal (PDO) for the surgical treatment of hallux valgus. Chir Organi Mov 90:365–369

    PubMed  CAS  Google Scholar 

  40. Trnka HJ, Zembsch A, Wiesauer H, Hungerford M, Salzer M, Ritschl P (1997) Modified Austin procedure for correction of hallux valgus. Foot Ankle Int 18:119–127

    Article  PubMed  CAS  Google Scholar 

  41. Wilson JN (1963) Oblique displacement osteotomy for hallux valgus. J Bone Joint Surg Br 45:552–556

    PubMed  CAS  Google Scholar 

  42. Pinney SJ, Song KR, Chou LB (2006) Surgical treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 27:970–973

    PubMed  Google Scholar 

  43. Pinney SJ, Song KR, Chou LB (2006) Surgical treatment of severe hallux valgus: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 27:1024–1029

    PubMed  Google Scholar 

  44. Maffulli N, Longo UG, Oliva F, Denaro V, Coppola C (2009) Bosch osteotomy and scarf osteotomy for hallux valgus correction. Orthop Clin N Am 40:515–524

    Article  Google Scholar 

  45. Myerson MS (2000) Hallux valgus. In: Myerson MS (ed) Foot and ankle disorders. WB Saunders, Philadelphia, pp 213–285

    Google Scholar 

  46. Wulker N (2005) Hallux valgus: distal first metatarsal osteotomy. In: Wulker N, Stephens MM, Cracchiolo A (eds) An atlas of foot and ankle surgery. Taylor & Francis, Abingdon, pp 9–17

    Chapter  Google Scholar 

  47. Nikolaou VS, Korres D, Xypnitos F, Lazarettos J, Lallos S, Sapkas G, Efstathopoulos N (2009) Fixation of Mitchell’s osteotomy with bioabsorbable pins for treatment of hallux valgus deformity. Int Orthop 33:701–706

    Article  PubMed  Google Scholar 

  48. Park CH, Ahn JY, Kim YM, Lee WC (2013) Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation. Int Orthop 37(6):1085–1092

    Google Scholar 

  49. Grace DL (1987) Metatarsal osteotomy: which operation? J Foot Surg 82:501–506

    Google Scholar 

  50. Giannini S, Faldini C, Vannini F, Digennaro V, Bevoni R, Luciani D (2008) The minimally invasive osteotomy “S.E.R.I”. (simple, effective, rapid, inexpensive) for correction of bunionette deformity. Foot Ankle Int 29:282–286

    Article  PubMed  Google Scholar 

  51. Giannini S, Faldini C, Vannini F, Cadossi M, Luciani D (2001) The minimally invasive hallux valgus correction (SERI). In: Wiesel SW (ed) Operative technique in orthopaedic surgery. Lippincott, Williams & Wilkins, Philadelphia, pp 3505–3511

    Google Scholar 

  52. Regnauld B (1986) Hallux rigidus. In: Elson R (ed) The foot. Springer, Berlin, pp 335–350

    Chapter  Google Scholar 

  53. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating system for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 15:349–353

    Article  PubMed  CAS  Google Scholar 

  54. Coughlin MJ, Saltzman CL, Nunley JA (2002) Angular measurements in the evaluation of hallux valgus deformities: a report of the Ad Hoc Committee of the American Orthopaedic Foot and Ankle Society on angular measurements. Foot Ankle Int 23:68–74

    PubMed  Google Scholar 

  55. Smith RW, Reynolds JC, Stewart MJ (1984) Hallux valgus assessment: report of research committee of American Orthopaedic Foot and Ankle Society. Foot Ankle 5:92–103

    Article  PubMed  CAS  Google Scholar 

  56. Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H (2009) Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am 91:1637–1645

    Article  PubMed  Google Scholar 

  57. Coughlin MJ (1997) Hallux valgus in men: effect of the distal metatarsal articular angle on hallux valgus correction. Foot Ankle Int 18:463–470

    Article  PubMed  CAS  Google Scholar 

  58. Giannini S, Cavallo M, Faldini C, Luciani D, Vannini F (2013) The SERI distal metatarsal osteotomy and scarf osteotomy provide similar correction of hallux valgus. Clin Orthop Relat Res 471(7):2305–2311

    Google Scholar 

  59. Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int 28:748–758

    Article  PubMed  Google Scholar 

  60. Coughlin MJ, Freund E, Roger A (2001) Mann award. The reliability of angular measurements in hallux valgus deformities. Foot Ankle Int 22:369–379

    PubMed  CAS  Google Scholar 

  61. Saltzman CL, Brandser EA, Berbaum KS, DeGnore L, Holmes JR, Katcherian DA, Teasdall RD, Alexander IJ (1994) Reliability of standard foot radiographic measurements. Foot Ankle Int 15:661–665

    Article  PubMed  CAS  Google Scholar 

  62. Schneider W, Csepan R, Knahr K (2003) Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg Am 85:494–499

    PubMed  Google Scholar 

  63. Chi TD, Davitt J, Younger A, Holt S, Sangeorzan BJ (2002) Intra- and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus. Foot Ankle Int 23:722–726

    PubMed  Google Scholar 

  64. Oliva F, Longo UG, Maffulli N (2009) Minimally invasive hallux valgus correction. Orthop Clin N Am 40:525–530

    Article  Google Scholar 

  65. Becker A (2009) First metatarsal malunion. Foot Ankle Clin N Am 14:77–90

    Article  Google Scholar 

  66. Belczyk R, Stapleton JJ, Grossman JP, Zgonis T (2009) Complications and revisional hallux valgus surgery. Clin Podiatr Med Surg 26:475–484

    Article  PubMed  Google Scholar 

  67. Nyska M (2001) Principles of first metatarsal osteotomies. Foot Ankle Clin 6:399–408

    Article  PubMed  CAS  Google Scholar 

  68. Okuda R, Kinoshita M, Morikawa J, Jotoku T, Abe M (2001) Surgical treatment for hallux valgus with painful plantar callosities. Foot Ankle Int 22:203–208

    PubMed  CAS  Google Scholar 

  69. Vora AM, Myerson MS (2005) First metatarsal osteotomy nonunion and malunion. Foot Ankle Clin 10:35–54

    Article  PubMed  Google Scholar 

  70. Weil LS (2000) Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results. Foot Ankle Clin 5:559–580

    PubMed  CAS  Google Scholar 

  71. Resch S, Stenstrom A, Gustafson T (1992) Circulatory disturbance of the first metatarsal head after chevron osteotomy as shown by bone scintigraphy. Foot Ankle 13:137–142

    Article  PubMed  CAS  Google Scholar 

  72. Kuhn MA, Lippert FG 3rd, Phipps MJ, Williams C (2005) Blood flow to the metatarsal head after chevron bunionectomy. Foot Ankle Int 26:526–529

    PubMed  Google Scholar 

  73. Goldman FD, Siegel J (1993) Extensor hallucis longus tendon transfer for correction of hallux varus. J Foot Ankle Surg 32:126–131

    PubMed  CAS  Google Scholar 

  74. Dhillon MS, Bali K, Prabhakar S (2011) Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg 95:171–181

    Article  PubMed  Google Scholar 

  75. Hawkins FB (1971) Acquired hallux valgus: cause, prevention and correction. Clin Orthop Relat Res 76:169–176

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy

    Sandro Giannini, Cesare Faldini, Deianira Luciani & Francesca Vannini

  2. Department of Rizzoli-Sicilia, Orthopaedic Service, The Rizzoli Institute, Bagheria, Italy

    Cesare Faldini, Matteo Nanni & Alberto Di Martino

  3. CIR-Center for Integrated Research, Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Alberto Di Martino

Authors
  1. Sandro Giannini
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  2. Cesare Faldini
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  3. Matteo Nanni
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  4. Alberto Di Martino
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  5. Deianira Luciani
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  6. Francesca Vannini
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Correspondence to Alberto Di Martino.

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Giannini, S., Faldini, C., Nanni, M. et al. A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). International Orthopaedics (SICOT) 37, 1805–1813 (2013). https://doi.org/10.1007/s00264-013-1980-8

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